The head of the NHS in London has issued a stark warning against “railroading” general practitioners into providing more neighbourhood health services, underscoring deep unease among primary care leaders about the pace and direction of NHS reform. The caution comes as neighbourhood models, involving care closer to home and expanded GP roles, become a central plank of the government’s 10-Year Health Plan.
NHS London’s intervention reflects concerns that too rapid a push for extended GP responsibilities: without adequate resourcing, workforce supply or contractual clarity, which could backfire. Primary care in London already grapples with heavy workloads and recruitment challenges, and critics say imposing extra duties risks further burnout and attrition among an already stretched workforce. Neighbourhood health services are a key part of national policy. The government’s recently highlighted Plan for Change envisages services such as same-day GP consultations, multidisciplinary teams and expanded roles for allied health professionals based in local community settings rather than hospitals. This “hospital-to-community” shift aims to reduce pressure on urgent care and elective services by keeping people well in their local areas.
London’s caution comes amid evidence that primary care pressure is already acute. Data from NHS England show that GP access initiatives like the Advice and Guidance scheme have diverted tens of thousands of potential referrals away from elective waiting lists by enabling GPs to get quick specialist input; a sign that primary care is being asked to play a broader coordination role. At the same time, workforce surveys remain concerning. A case study in NHS London planning guidance highlights that almost half of the GPs are unlikely to still be working in general practice in five years’ time, and many cite lack of time, rather than only pay, as a barrier to evolving roles successfully. That points to the risk behind pushing neighbourhood service expansion at pace without addressing underlying capacity constraints.
Primary care is also central to structural reform beyond neighbourhood services. In 2025, policy proposals outlined new GP contract models intended to support services across larger areas: including “single neighbourhood providers” covering about 50,000 people and “multi-neighbourhood providers” serving around 250,000, suggesting a shift towards more integrated, scaled roles for practices. However, this transition raises legitimate questions about whether GPs and practices are being equipped, funded and supported to take this on.
The London boss’s warning also signals tension between strategic direction and frontline realities. Integrated care boards (ICBs) are increasingly approving neighbourhood service integrators to coordinate community care, and some areas are trialling multidisciplinary teams to deliver neighbourhood-based urgent care. While these pilots reflect policy intent, they also depend on general practice capacity and clinician willingness to embrace expanded roles.
GP representatives have previously raised concerns about neighbourhood care models. Some argue that policymakers must avoid brushing aside the professional autonomy core to general practice, particularly when models envisaged by national strategy appear to reframe GPs as operational leads within larger, non-GP-led structures. This resonates with London’s caution about railroading.
